Expert Q&A: Christian Lanphere from Cambridge Health Alliance in MA

The ‘Expert Q&A’ series highlights the experiences of practitioners and thought-leaders in the field of Emergency Management & Response.

Christian Lanphere is the Director of Emergency Management & CHA Safety Officer for the Cambridge Health Alliance in Massachusetts.

Omnilert: Tell us about yourself.

Christian Lanphere: Most of my experiences have been in the emergency arena. I've worked in level one trauma centers, as a paramedic, and firefighter / EMS. I have been with the Cambridge Health Alliance for about twelve years now. We are a complex system in that we are a quasi-public authority healthcare system.

We are a 3 campus, 3 hospital system with about 30 ambulatory health centers in 5 communities in the metro-Boston area. Cambridge Health Alliance has the opportunity to work with different communities which can sometimes conflict with other communities we partner with. Each public safety agency has their own way of doing things so managing that and streamlining our operations to insure we have, and provide, consistency across the board can be challenging. Streamlining care, predominantly in an emergency situation is where the public expects us to be consistent from one facility to another. One of the best practices in the Boston area from an emergency preparedness standpoint is that, although the hospitals are very competitive, we all come together during times of emergencies or crises (we've been doing this for 25 to 30 years now). We are aligned and our emergency plans are similar so there is consistency for care when a disaster strikes. We have the opportunity to work with our local, state, and federal counterparts to ensure that we have a more cohesive plan and can respond much better together. I’d like to think what happened at the Boston Marathon showed that.

I am the Director of Emergency Management and Health and Safety Officer. The role of the Safety Officer is to ensure workplace safety and ensure that we follow all the regulations pertaining to the environment of the buildings- making sure we are up to code so that we stay within the regulations from the state and federal government. From the emergency preparedness standpoint I manage the plans - not only within the Public Health and EMS community, but also within the hospital to ensure that we are providing care during evacuations, chemical, biological, and radiological events or mass casualty events in the community, etc.

Omnilert: What is your favorite part about your job?

CL: I think the emergency management role is my favorite part. As the Safety Officer, though I have to serve as the rule enforcer so I don’t think people like that so much, we all have to stay within the rules to ensure we are providing a safe atmosphere for not only our patients, but for our staff and visitors alike. I like to think of it as when people have a problem they come to me and we try to find a solution. So in that regard, it's not a bad part of the job. People find that if there is an issue that cannot be resolved they will come to me. But I think the emergency management piece is my favorite because its continuously evolving. It allows us to network with the local, state, and federal agencies and plan together.

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Omnilert: How does your position tie in with emergency communications regarding Omnilert?

CL: We experienced one of the biggest lessons learned. There are about 17 hospitals in the Boston area, so there are a lot of us. Consider the Boston Marathon bombing that happened - not so much the bombing itself, but the manhunt that occurred later in week - and I live only four blocks from it. They started shutting down parts of the city, so not only was my community, Watertown, shut down but Cambridge, the neighboring community where our main hospital is, was shut down too. And the suspects only lived a few blocks from our hospital so there was a lot of security. Our staff was very unsure about what to do - should we leave? come to work? stay home? We didn't have a system to communicate to them and since it occurred during late night hours there was no communication medium. We are a Harvard teaching hospital institution, so Harvard was sending mass notifications to our providers. Given that, we had limited ability to get to staff and provide direction. That is why I bought the Alertus system - I found it at the IAEM national conference in the EMEX vendor show. What led us to Omnilert, was that Alertus works with the Omnilert system. That was the initial attractiveness to Omnilert. We looked into other systems, given that Boston has used other systems, but none were successful. So we decided to go with Omnilert.

I would say our only challenge with Omnilert, initially once we got it, was getting folks to sign up. They won't voluntarily sign up. If we make it easy for them to sign up they will. Once we worked with the Omnilert support team and built it in with our internal system, it now works great.

I am responsible for the system, but IT manages it for me, keeps it up, pay the bill - but I am the leader for it, though. We had a situation where something was sent out erroneously by our group so now we've really tightened it up. Very few people have the ability to send something out, and we do that so it cannot be abused. If it gets abused, people will immediately drop off of it. We try to use it only when we absolutely have to - only because people will start unrolling if it's used for purposes other than emergency notification.

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Omnilert: How is Omnilert implemented at Cambridge Health Alliance?

CL: It is a voluntary system, but during orientation we bring up the site and urge every employee to sign up. Then, during onboarding, they also get an email telling them how to register. Every three months we send out a blast to everyone to urge them to sign up, and then during major snowstorms or before a major weather event we will also encourage people. Most people sign up just before a storm occurs.

When people leave our organization they are taken out of our internal system and automatically come out of the Omnilert system, which is great. They are already pulled out, so they aren't constantly bombarding us to remove them.

Over this last winter, while we had a mild winter, I overheard people in the hall saying how great it was because they knew before every storm where to park and what to do, and we no longer have to have people call a hotline. Some of the issues with the hotline was that if we did not update it, our staff were lost. Given the mass notification system technology, we can send emails to people, text messages, etc., and if it is urgent we will send a voice call.

We have some Scenarios in place, but honestly I don’t frequently use them because we have some really unique situations. I do like how i can use Scenarios on my phone, and I can also use my iPhone to log into our full account to get something out to everyone.

We also have different alerts in there now so if our primary paging system goes down we use Omnilert as our backup. We don't send a lot of emergency communications, so we use it as backup for paging system, too. It gets a lot more use and people become more comfortable with it. They are being more accustomed to it and familiar with how it works.

We’ve reduced the number of people who can actually send a message. There is always someone in house who can do it, but it's such a small number we’d like to think it reduces human error. Typically during storms we will train, and each admin will go send a message to keep them refreshed. When we do table top exercises we may not send a message, but we talk through it. It's an organization of 5,000-6,000 people in five different cities. It’s part of our nomenclature now and part of everyday stuff. We do have to reduce error rates, so just like our email system only a few people can send out a mass email.

We have 13 different groups within the system for different things - the Department of Medicine has one, the Department of Surgery has their own, the Incident Command Center at one hospital (and others) have their own distribution groups within the site, but employees are altogether in one group. We do that deliberately so they are all aware of what is happening at their sister campuses. When something happens everyone knows what is going on at another facility. For instance, If we have to close a facility to ambulance traffic, they are going to go to another facility - so the facility getting the rerouted ambulances must be made aware.

It is working really really well for us. The support team at Omnilert worked with our IT department- they spoke the same language- and now we have a really good system.

We highly recommended Omnilert to the other hospital in Cambridge and they have it now. We got Omnilert not necessarily immediately after the Boston Marathon bombing in 2013, but within 6 months of the occurrence.

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Omnilert: Can you tell me about your team?

CL: We are required by the federal government to implement the Incident Command System as part of grant funding requirements.. Our Incident Commander is our Chief Medical Officer and we have a Public Information Officer who is trained- so we will go through that system. If things are happening there are different teams in the hospital that report to us at the Incident Command Center where the Incident Commander will make final decisions on things. I think of them as the players and I am the coach. I am not the one in charge making the decisions, but I am the one helping guide us to those decisions. This is not their everyday job and they don't use it everyday. It is my job to be sure they are following all the regulations they are supposed to.

In every real event and every drill, communication is always at the top of the list of problems. We have made our fair share of mistakes - we try to minimize them as much as possible. For example, our computer system went down and we inadvertently sent a mass message at 2 in the morning, so it woke a lot of people up. We had a lot of unhappy folks. This is why we are very careful about who has access now and who can send out information.

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Omnilert: Can you talk about a time Cambridge Health Alliance has had to utilize Omnilert? What happened?

CL: The winter of 2015 was really our first test. We were able to communicate and our staff love it. I don't know if you’ve been to Boston, but parking is almost impossible here which is an issue for our staff. The streets got smaller and smaller because there was nowhere to put the snow. So people really relied on those updates for information about what they needed to do. People are now relying on it pretty heavily.

We put different protocols in place for when it's appropriate to send a text versus a phone call or email. Like everything with IT, I think it starts out slow and then once a major event happens more people sign on. That's exactly what happened. More and more people signed on.

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Omnilert: How did emergency and critical communications take place before Omnilert was implemented?

CL: We were sending emails to everyone but most of the staff cannot get email outside of the building. So if they aren’t at work, we can’t communicate with them. We were also relying on staff and training them to call a hotline if there was a problem, but it was very fractured, very unreliable, they would forget the number, and sometimes the hotline wouldn't be updated. Having a real time system so people can get instantaneous information now is an enormous improvement over what we had. With the Boston Marathon, we also realized the phone lines got so tied up so people couldn't call in. We were trying to tell staff to stay in place. The phones lines were so overloaded with parents, friends, and family calling each other to check on each other.

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Omnilert: What advice would you give similar organizations in regards to emergency response plans and coordination?

CL: Keep plans current and you have to train your staff and keep the information current. It can’t always be the same person who is always setting it off. Different people have to have an opportunity to try it to get comfortable with it and build confidence. If I’m not here and they have not used it, walking someone through it slows it down. People expect information quickly. Keep your plans up to date and allow others to test it out and use it. It's a very easy system to use even if computer illiterate, but it takes time and we want to reduce that amount of time.

The media pushes out information very fast and it's not always accurate, so we want to get information out to let people know we are on top of it. For instance -there was a big club fire out in Rhode Island in 2003 and the major trauma center didn't even get notified, but there was a TV in the emergency room showing the news and that is how they were alerted. They geared up quickly after being notified through the media. With the Omnilert system, I think using it leads to more trust and credibility with our staff.